On-pump coronary artery bypass graft operation: Is one crossclamp application better than two?

Juan C. Araque, Kevin L. Greason, Zhuo Li, Courtney N. Heins, John M. Stulak, Richard C. Daly, Lyle D. Joyce, Rakesh M. Suri, Chaim Locker, Hartzell V Schaff

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

OBJECTIVES: Several factors may increase the risk of stroke during coronary artery bypass grafting. These include age and atherosclerosis, which are not modifiable, and aortic manipulation, which may be modifiable. This study reports our experience with variable degrees of aortic manipulation (ie, single vs double [partial occlusion] aortic crossclamp techniques) and its influence on rate of operative stroke.

METHODS: We performed a retrospective review of 8497 patients treated with isolated on-pump coronary artery bypass grafting from 1993 to 2010. Demographics included an age of 66.8 ± 10.3 years and male sex in 6548 patients (77.1%). Operative technique used the single aortic crossclamp in 2051 patients (24.1%) and the partial aortic crossclamp in 6446 patients (75.9%). To adjust for differences in baseline patient characteristics, 2 propensity-matched cohorts of 1333 patients each were created using Society of Thoracic Surgeons risk calculator variables.

RESULTS: In the unmatched cohorts, stroke occurred in 25 patients (1.2%) in the single aortic crossclamp cohort and in 98 patients (1.5%) in the partial aortic crossclamp cohort (P = .320). Logistic regression analysis demonstrated no significant relationship between stroke and aortic occlusion clamp technique (single clamp odds ratio, 0.80; 95% confidence interval, 0.51-1.24; P = .321). In the matched cohorts, stroke occurred in 16 patients (1.2%) in both the single and partial occlusion clamp cohorts (P = 1.00).

CONCLUSIONS: Given the methods and limitations of the data analysis, the single and partial aortic crossclamp techniques result in similar rates of stroke during on-pump coronary artery bypass grafting.

Original languageEnglish (US)
Pages (from-to)145-149
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume150
Issue number1
DOIs
StatePublished - Jul 1 2015

Fingerprint

Coronary Artery Bypass
Transplants
Stroke
Atherosclerosis
Logistic Models
Odds Ratio
Regression Analysis
Demography
Confidence Intervals

Keywords

  • Coronary artery bypass grafting
  • death
  • postoperative complication
  • stroke

ASJC Scopus subject areas

  • Medicine(all)

Cite this

On-pump coronary artery bypass graft operation : Is one crossclamp application better than two? / Araque, Juan C.; Greason, Kevin L.; Li, Zhuo; Heins, Courtney N.; Stulak, John M.; Daly, Richard C.; Joyce, Lyle D.; Suri, Rakesh M.; Locker, Chaim; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 150, No. 1, 01.07.2015, p. 145-149.

Research output: Contribution to journalArticle

Araque, JC, Greason, KL, Li, Z, Heins, CN, Stulak, JM, Daly, RC, Joyce, LD, Suri, RM, Locker, C & Schaff, HV 2015, 'On-pump coronary artery bypass graft operation: Is one crossclamp application better than two?', Journal of Thoracic and Cardiovascular Surgery, vol. 150, no. 1, pp. 145-149. https://doi.org/10.1016/j.jtcvs.2015.04.010
Araque, Juan C. ; Greason, Kevin L. ; Li, Zhuo ; Heins, Courtney N. ; Stulak, John M. ; Daly, Richard C. ; Joyce, Lyle D. ; Suri, Rakesh M. ; Locker, Chaim ; Schaff, Hartzell V. / On-pump coronary artery bypass graft operation : Is one crossclamp application better than two?. In: Journal of Thoracic and Cardiovascular Surgery. 2015 ; Vol. 150, No. 1. pp. 145-149.
@article{00429b19c72145a0a7fae6ee9509f23e,
title = "On-pump coronary artery bypass graft operation: Is one crossclamp application better than two?",
abstract = "OBJECTIVES: Several factors may increase the risk of stroke during coronary artery bypass grafting. These include age and atherosclerosis, which are not modifiable, and aortic manipulation, which may be modifiable. This study reports our experience with variable degrees of aortic manipulation (ie, single vs double [partial occlusion] aortic crossclamp techniques) and its influence on rate of operative stroke.METHODS: We performed a retrospective review of 8497 patients treated with isolated on-pump coronary artery bypass grafting from 1993 to 2010. Demographics included an age of 66.8 ± 10.3 years and male sex in 6548 patients (77.1{\%}). Operative technique used the single aortic crossclamp in 2051 patients (24.1{\%}) and the partial aortic crossclamp in 6446 patients (75.9{\%}). To adjust for differences in baseline patient characteristics, 2 propensity-matched cohorts of 1333 patients each were created using Society of Thoracic Surgeons risk calculator variables.RESULTS: In the unmatched cohorts, stroke occurred in 25 patients (1.2{\%}) in the single aortic crossclamp cohort and in 98 patients (1.5{\%}) in the partial aortic crossclamp cohort (P = .320). Logistic regression analysis demonstrated no significant relationship between stroke and aortic occlusion clamp technique (single clamp odds ratio, 0.80; 95{\%} confidence interval, 0.51-1.24; P = .321). In the matched cohorts, stroke occurred in 16 patients (1.2{\%}) in both the single and partial occlusion clamp cohorts (P = 1.00).CONCLUSIONS: Given the methods and limitations of the data analysis, the single and partial aortic crossclamp techniques result in similar rates of stroke during on-pump coronary artery bypass grafting.",
keywords = "Coronary artery bypass grafting, death, postoperative complication, stroke",
author = "Araque, {Juan C.} and Greason, {Kevin L.} and Zhuo Li and Heins, {Courtney N.} and Stulak, {John M.} and Daly, {Richard C.} and Joyce, {Lyle D.} and Suri, {Rakesh M.} and Chaim Locker and Schaff, {Hartzell V}",
year = "2015",
month = "7",
day = "1",
doi = "10.1016/j.jtcvs.2015.04.010",
language = "English (US)",
volume = "150",
pages = "145--149",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - On-pump coronary artery bypass graft operation

T2 - Is one crossclamp application better than two?

AU - Araque, Juan C.

AU - Greason, Kevin L.

AU - Li, Zhuo

AU - Heins, Courtney N.

AU - Stulak, John M.

AU - Daly, Richard C.

AU - Joyce, Lyle D.

AU - Suri, Rakesh M.

AU - Locker, Chaim

AU - Schaff, Hartzell V

PY - 2015/7/1

Y1 - 2015/7/1

N2 - OBJECTIVES: Several factors may increase the risk of stroke during coronary artery bypass grafting. These include age and atherosclerosis, which are not modifiable, and aortic manipulation, which may be modifiable. This study reports our experience with variable degrees of aortic manipulation (ie, single vs double [partial occlusion] aortic crossclamp techniques) and its influence on rate of operative stroke.METHODS: We performed a retrospective review of 8497 patients treated with isolated on-pump coronary artery bypass grafting from 1993 to 2010. Demographics included an age of 66.8 ± 10.3 years and male sex in 6548 patients (77.1%). Operative technique used the single aortic crossclamp in 2051 patients (24.1%) and the partial aortic crossclamp in 6446 patients (75.9%). To adjust for differences in baseline patient characteristics, 2 propensity-matched cohorts of 1333 patients each were created using Society of Thoracic Surgeons risk calculator variables.RESULTS: In the unmatched cohorts, stroke occurred in 25 patients (1.2%) in the single aortic crossclamp cohort and in 98 patients (1.5%) in the partial aortic crossclamp cohort (P = .320). Logistic regression analysis demonstrated no significant relationship between stroke and aortic occlusion clamp technique (single clamp odds ratio, 0.80; 95% confidence interval, 0.51-1.24; P = .321). In the matched cohorts, stroke occurred in 16 patients (1.2%) in both the single and partial occlusion clamp cohorts (P = 1.00).CONCLUSIONS: Given the methods and limitations of the data analysis, the single and partial aortic crossclamp techniques result in similar rates of stroke during on-pump coronary artery bypass grafting.

AB - OBJECTIVES: Several factors may increase the risk of stroke during coronary artery bypass grafting. These include age and atherosclerosis, which are not modifiable, and aortic manipulation, which may be modifiable. This study reports our experience with variable degrees of aortic manipulation (ie, single vs double [partial occlusion] aortic crossclamp techniques) and its influence on rate of operative stroke.METHODS: We performed a retrospective review of 8497 patients treated with isolated on-pump coronary artery bypass grafting from 1993 to 2010. Demographics included an age of 66.8 ± 10.3 years and male sex in 6548 patients (77.1%). Operative technique used the single aortic crossclamp in 2051 patients (24.1%) and the partial aortic crossclamp in 6446 patients (75.9%). To adjust for differences in baseline patient characteristics, 2 propensity-matched cohorts of 1333 patients each were created using Society of Thoracic Surgeons risk calculator variables.RESULTS: In the unmatched cohorts, stroke occurred in 25 patients (1.2%) in the single aortic crossclamp cohort and in 98 patients (1.5%) in the partial aortic crossclamp cohort (P = .320). Logistic regression analysis demonstrated no significant relationship between stroke and aortic occlusion clamp technique (single clamp odds ratio, 0.80; 95% confidence interval, 0.51-1.24; P = .321). In the matched cohorts, stroke occurred in 16 patients (1.2%) in both the single and partial occlusion clamp cohorts (P = 1.00).CONCLUSIONS: Given the methods and limitations of the data analysis, the single and partial aortic crossclamp techniques result in similar rates of stroke during on-pump coronary artery bypass grafting.

KW - Coronary artery bypass grafting

KW - death

KW - postoperative complication

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=84941072179&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941072179&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2015.04.010

DO - 10.1016/j.jtcvs.2015.04.010

M3 - Article

C2 - 25963439

AN - SCOPUS:84941072179

VL - 150

SP - 145

EP - 149

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 1

ER -